IMG_5581.jpeg
Commons cases at opd at this hospital and make prescriptions also. I want to learn prescriptions writing
analyse_media
Reading File
This is Ved Multispeciality Hospital in Gujarat, India. Based on the departments visible - Orthopedics, Pediatrics, Physician & Surgical, NICU/ICU, and Gynecology & Sonography - here are the most common OPD cases seen at such a multispeciality hospital, each with a realistic sample prescription.
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Common OPD Cases at Ved Multispeciality Hospital - with Sample Prescriptions
How to Read a Prescription
Every prescription must include:
- Patient details: Name, Age, Sex, Date
- Chief complaint / Diagnosis
- Rx (from Latin recipe = "take this")
- Drug name | Dose | Route | Frequency | Duration
- SIG: Special instructions
- Doctor's name, registration number, signature
DEPARTMENT 1: PHYSICIAN (General Medicine)
Case 1: Upper Respiratory Tract Infection (URTI) / Common Cold
History: 25-year-old male, 3 days sore throat, runny nose, mild fever (100°F), no cough.
Diagnosis: Acute URTI (viral)
╔══════════════════════════════════════════════════════════╗
║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ PHYSICIAN OPD ║
╚══════════════════════════════════════════════════════════╝
Patient: Ramesh Patel Age: 25 yrs Sex: M
Date: 03/08/2026 Weight: 68 kg
Diagnosis: Acute Viral URTI
Rx
──────────────────────────────────────────────────────────
1. Tab. Paracetamol 500 mg — 1 tab TDS × 3 days
(If fever >99°F or headache)
2. Tab. Cetirizine 10 mg — 1 tab OD at night × 5 days
(For nasal congestion/runny nose)
3. Syp. Betadine Gargle — Gargle with warm water BD × 5 days
4. Tab. Vitamin C 500 mg — 1 tab OD × 7 days
Advice:
• Steam inhalation twice daily
• Plenty of warm fluids, rest
• Avoid cold foods/drinks
• Return if fever persists >3 days or breathing difficulty
Dr. _______________
MBBS, MD (Medicine)
Reg No: GUJ/XXXX
╚══════════════════════════════════════════════════════════╝
Key learning: Viral URTI does NOT need antibiotics. Paracetamol for symptomatic relief, antihistamine for nasal symptoms.
Case 2: Hypertension (Follow-up)
History: 52-year-old male, known hypertensive, BP today = 150/96 mmHg, no chest pain, no breathlessness.
Diagnosis: Essential Hypertension (Stage 1-2), on medication.
╔══════════════════════════════════════════════════════════╗
║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ PHYSICIAN OPD ║
╚══════════════════════════════════════════════════════════╝
Patient: Mahesh Shah Age: 52 yrs Sex: M
Date: 03/08/2026 BP: 150/96 Weight: 82 kg
Diagnosis: Essential Hypertension (follow-up)
Rx
──────────────────────────────────────────────────────────
1. Tab. Amlodipine 5 mg — 1 tab OD (morning) × 30 days
(Calcium channel blocker)
2. Tab. Telmisartan 40 mg — 1 tab OD (morning) × 30 days
(ARB — avoid if pregnant)
3. Tab. Aspirin 75 mg — 1 tab OD after meals × 30 days
(If cardiovascular risk factor present)
Investigations Advised:
• FBS, PPBS (Fasting/Post-prandial blood sugar)
• Serum creatinine, urea
• ECG
• Lipid profile
Advice:
• Salt restriction (<5g NaCl/day)
• Daily walking 30 minutes
• Weight reduction target
• Home BP monitoring — record and bring chart
• Follow up after 1 month
Dr. _______________
MBBS, MD (Medicine)
╚══════════════════════════════════════════════════════════╝
Case 3: Type 2 Diabetes Mellitus (New case)
History: 46-year-old female, increased thirst, frequent urination, FBS = 180 mg/dL, HbA1c = 8.2%.
╔══════════════════════════════════════════════════════════╗
║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ PHYSICIAN OPD ║
╚══════════════════════════════════════════════════════════╝
Patient: Savita Mehta Age: 46 yrs Sex: F
Date: 03/08/2026 FBS: 180 mg/dL HbA1c: 8.2%
Diagnosis: Type 2 Diabetes Mellitus (newly diagnosed)
Rx
──────────────────────────────────────────────────────────
1. Tab. Metformin 500 mg — 1 tab BD after meals × 30 days
(Titrate to 1000 mg BD after 2 weeks if tolerated)
2. Tab. Glimepiride 1 mg — 1 tab OD before breakfast × 30 days
3. Cap. Methylcobalamin 500 mcg — 1 cap OD × 30 days
(Vitamin B12 — given with Metformin to prevent deficiency)
Investigations Advised:
• HbA1c (repeat at 3 months)
• Urine microalbumin/creatinine ratio
• Lipid profile
• Serum creatinine
• Fundus examination (ophthalmology referral)
Advice:
• Low-carb diet, avoid sugar, rice, maida
• 30 minutes walking daily
• Do NOT skip meals (risk of hypoglycemia)
• Monitor blood sugar at home if possible
• Follow up after 1 month
Dr. _______________
MBBS, MD (Medicine)
╚══════════════════════════════════════════════════════════╝
DEPARTMENT 2: PEDIATRICS (Balrog Vibhag)
Case 4: Acute Gastroenteritis in Child
History: 4-year-old boy, loose watery stools x 5 episodes/day, vomiting x 3, no blood in stool, mild fever. Weight = 16 kg.
╔══════════════════════════════════════════════════════════╗
║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ PEDIATRIC OPD ║
╚══════════════════════════════════════════════════════════╝
Patient: Arjun Patel Age: 4 yrs Sex: M
Date: 03/08/2026 Weight: 16 kg
Diagnosis: Acute Gastroenteritis (viral, no dehydration)
Rx
──────────────────────────────────────────────────────────
1. ORS (Oral Rehydration Salts) — 75 mL/kg over 4 hours
→ Approx 200 mL after each loose stool
(Give slowly with spoon)
2. Syp. Zinc 20 mg/5 mL — 1 tsp OD × 14 days
(Reduces severity and duration of diarrhea)
3. Syp. Domperidone 5 mg/5 mL — 1 tsp TDS before meals × 3 days
(For vomiting; dose = 0.3 mg/kg/dose)
4. Syp. Paracetamol 125 mg/5 mL — 1.5 tsp TDS if temp >38°C × 3 days
(Dose = 15 mg/kg/dose; 16 kg × 15 = 240 mg ~ 240/125 × 5 = ~10 mL)
NOTE: Antibiotics NOT required for viral gastroenteritis.
Advice:
• Do NOT stop breastfeeding/feeds
• Continue normal diet (BRAT: Banana, Rice, Apple, Toast)
• Signs to return IMMEDIATELY: sunken eyes, no urine for 6 hrs,
blood in stool, seizures, lethargy
• Follow up in 24-48 hours
Dr. _______________
MBBS, MD (Pediatrics)
╚══════════════════════════════════════════════════════════╝
Pediatric prescription key rule: Always calculate dose by weight (mg/kg). Never use adult doses.
Case 5: Febrile URTI in Child (with antibiotic)
History: 6-year-old girl, high fever (103°F) x 3 days, ear pain, congested, tympanic membrane red on exam. Weight = 20 kg.
Diagnosis: Acute Otitis Media
╔══════════════════════════════════════════════════════════╗
║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ PEDIATRIC OPD ║
╚══════════════════════════════════════════════════════════╝
Patient: Priya Desai Age: 6 yrs Sex: F
Date: 03/08/2026 Weight: 20 kg Temp: 103°F
Diagnosis: Acute Otitis Media (bacterial)
Rx
──────────────────────────────────────────────────────────
1. Syp. Amoxicillin 250 mg/5 mL — 4 tsp TDS × 7 days
(Dose: 40 mg/kg/day; 40×20=800 mg/day ÷ 3 = ~267 mg/dose)
2. Syp. Ibuprofen 100 mg/5 mL — 2 tsp TDS after meals × 5 days
(Dose: 10 mg/kg/dose; analgesic + antipyretic for ear pain)
3. Syp. Cetirizine 5 mg/5 mL — 2 tsp OD at night × 5 days
(Antihistamine for nasal congestion)
4. Nasal drops Xylometazoline 0.05% — 2 drops each nostril BD × 5 days
(Decongestant — helps drain middle ear)
Advice:
• Warm compress over ear for pain relief
• No swimming/water in ears
• Complete the full antibiotic course
• Return if no improvement in 48-72 hours
Dr. _______________
MBBS, MD (Pediatrics)
╚══════════════════════════════════════════════════════════╝
DEPARTMENT 3: ORTHOPEDICS
Case 6: Acute Low Back Pain (Lumbago)
History: 38-year-old male, sudden low back pain after lifting heavy object, no radiation to legs, no bladder/bowel changes. X-ray normal.
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║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ ORTHOPEDIC OPD ║
╚══════════════════════════════════════════════════════════╝
Patient: Dinesh Kumar Age: 38 yrs Sex: M
Date: 03/08/2026
Diagnosis: Acute Mechanical Low Back Pain (muscle strain)
Rx
──────────────────────────────────────────────────────────
1. Tab. Diclofenac + Paracetamol (50/500 mg)
— 1 tab BD after meals × 5 days
(NSAID + Analgesic combination)
2. Tab. Thiocolchicoside 4 mg — 1 tab BD × 5 days
(Muscle relaxant — reduces spasm)
3. Tab. Pantoprazole 40 mg — 1 tab OD before breakfast × 5 days
(Gastric protection while on NSAIDs)
4. Diclofenac gel 1% — Apply locally over painful area TDS × 7 days
(Topical NSAID)
Advice:
• Rest for 2-3 days, avoid heavy lifting
• Apply warm compress locally
• Lumbar support/belt while standing/walking
• Physiotherapy after acute pain subsides
• Return if pain radiates to legs, numbness, or weakness
Investigations (if no improvement in 2 weeks):
• MRI Lumbosacral spine
Dr. _______________
MBBS, MS (Ortho)
╚══════════════════════════════════════════════════════════╝
Key rule: Always add PPI (proton pump inhibitor) when prescribing NSAIDs to protect the stomach.
Case 7: Osteoarthritis of Knee
History: 62-year-old female, bilateral knee pain, morning stiffness < 30 minutes, crepitus on movement, X-ray shows joint space narrowing.
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║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ ORTHOPEDIC OPD ║
╚══════════════════════════════════════════════════════════╝
Patient: Kantaben Joshi Age: 62 yrs Sex: F
Date: 03/08/2026
Diagnosis: Bilateral Knee Osteoarthritis (Grade II)
Rx
──────────────────────────────────────────────────────────
1. Tab. Etoricoxib 60 mg — 1 tab OD after meals × 10 days
(COX-2 inhibitor; better GI safety than non-selective NSAIDs)
2. Tab. Pantoprazole 40 mg — 1 tab OD before breakfast × 10 days
3. Tab. Glucosamine + Chondroitin (750/600 mg)
— 1 tab BD × 3 months
(Cartilage support; long-term use)
4. Tab. Calcium + Vitamin D3 (500 mg/250 IU)
— 1 tab BD × 3 months
5. Diclofenac gel 1% — Apply to knees TDS
Physiotherapy: Refer for quadriceps strengthening exercises
Advice:
• Weight reduction (reduces load on knees)
• Avoid squatting, climbing stairs excessively
• Swimming/cycling preferred over walking on hard surfaces
• Follow up at 1 month
Dr. _______________
MBBS, MS (Ortho)
╚══════════════════════════════════════════════════════════╝
DEPARTMENT 4: GYNECOLOGY (Gaynak Vibhag)
Case 8: Dysmenorrhea (Painful Periods)
History: 22-year-old female, severe crampy lower abdominal pain during 1st-2nd day of menses, regular cycles, no discharge, USG pelvis normal.
Diagnosis: Primary Dysmenorrhea
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║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ GYNECOLOGY OPD ║
╚══════════════════════════════════════════════════════════╝
Patient: Neha Patel Age: 22 yrs Sex: F
Date: 03/08/2026
Diagnosis: Primary Dysmenorrhea
Rx
──────────────────────────────────────────────────────────
1. Tab. Mefenamic acid 500 mg — 1 tab TDS × 3-5 days
(Start 1 day before expected menses; COX inhibitor)
2. Tab. Drotaverine 40 mg — 1 tab TDS × 3 days
(Antispasmodic — relaxes uterine smooth muscle)
3. Tab. Ferrous fumarate + Folic acid — 1 tab OD × 30 days
(Iron supplementation if menorrhagia present)
Advice:
• Warm compress over lower abdomen
• Light exercise, yoga (especially child's pose)
• Avoid caffeine during periods
• If pain is severe/not responding, pelvic USG + follow up
Dr. _______________
MBBS, MS (Gynaecology)
╚══════════════════════════════════════════════════════════╝
DEPARTMENT 5: NICU/Pediatric - Neonatal Case
Case 9: Neonatal Jaundice (for parent counseling, non-prescription case)
For educational purposes - neonatal jaundice management is done in NICU, not via outpatient prescription. Treatment is phototherapy, not drugs. This is important to know.
Prescription Writing - Key Rules to Remember
| Rule | Details |
|---|---|
| Legibility | Write clearly; illegible prescriptions are dangerous |
| Abbreviations | OD = once daily, BD = twice daily, TDS = three times daily, QID = four times daily, HS = at bedtime, AC = before meals, PC = after meals |
| Dose calculation in children | Always calculate per kg body weight |
| PPI with NSAIDs | Mandatory to protect gastric mucosa |
| Antibiotics | Only prescribe with clear bacterial indication; always mention duration |
| Controlled drugs | Require special prescription pad (Schedule H1/X in India) |
| Generic names | Preferred over brand names (Government of India mandate) |
| Signature + Reg. No. | Mandatory - prescription is a legal document |
| Date | Always write date - prevents misuse |
| Diagnosis | Writing diagnosis helps pharmacist and patient understand |
Disclaimer: These are educational sample prescriptions for learning purposes only. All real prescriptions must be written by a licensed medical doctor after examining the patient. Drug doses should always be verified against current formularies.
B8BED116-0469-45D6-9481-A10203653F96.jpeg
45/F having RLQ pain since 1 week
analyse_media
Finding Sources
USG report read. Let me now search the medical library for ovarian cyst and RLQ pain management in parallel.
Finding Sources
Finding Sources
Reading File
Reading File
Excellent - I now have all the information needed for a complete clinical analysis. Here is the full case breakdown:
Clinical Case: 45/F with Right Lower Quadrant (RLQ) Pain - 1 Week
USG Abdomen Report - Key Findings (Dr. Naresh Hundiya Imaging Centre, Nadiad)
Patient: Sumitraben Gohel | Date: 29-Mar-2025 | Age: 45 years, Female
| Organ | Finding |
|---|---|
| Liver | Increased echogenicity (fatty liver) |
| Gallbladder | Normal, no stones |
| Kidneys | Bilateral normal (10.5 cm) |
| Uterus | Normal size, retroverted, cavity empty, endometrium normal |
| Right Ovary | Thin-walled simple cyst - 2.1 cm × 1.6 cm, no internal echoes, no septations |
| Left Ovary | Normal |
| Appendix | Operated (previously removed - appendix is NOT the cause) |
| Bowel | Fluid-filled small bowel loops noted, no terminal ileal thickening |
| Peritoneum | No free fluid, no lymphadenopathy |
Radiologist's Impression: Simple Right Ovarian Cyst + Fatty Liver
Differential Diagnosis - Why RLQ Pain in This Patient?
Since the appendix has already been operated, appendicitis is ruled out. The differentials narrow significantly:
| # | Diagnosis | Evidence In This Case |
|---|---|---|
| 1 | Simple Right Ovarian Cyst (MOST LIKELY) | USG confirmed 2.1 × 1.6 cm thin-walled cyst, no internal echoes |
| 2 | Ovarian Torsion | Less likely - cyst is small (2.1 cm), but cannot fully exclude |
| 3 | Corpus Luteum Cyst pain | Possible - she is 45, perimenopausal |
| 4 | Mesenteric/bowel cause | Fluid-filled bowel loops noted - mild IBS/gastritis possible |
| 5 | Musculoskeletal | Cannot exclude on USG alone |
| 6 | Endometrioma | Less likely - cyst is simple/thin-walled (not ground-glass) |
"Follicular cysts typically resolve in 4 to 8 weeks with expectant management. Corpus luteum cysts can cause pain, presumably because of bleeding into the enclosed ovarian cyst cavity." - Berek & Novak's Gynecology, p.452
Important Clinical Points
- At 45 years, she may be perimenopausal - functional cysts are still common
- A 2.1 cm simple cyst with no internal echoes/septations has an extremely low malignancy risk
- Appendix is already removed - so no appendicitis risk
- Fatty liver found incidentally - needs dietary/lifestyle counseling
Sample Prescription
╔══════════════════════════════════════════════════════════════╗
║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ GYNECOLOGY / PHYSICIAN OPD ║
╚══════════════════════════════════════════════════════════════╝
Patient: Sumitraben Gohel Age: 45 yrs Sex: F
Date: 03/08/2026 Weight: ___kg
Chief Complaint: RLQ pain × 1 week
USG Impression: Simple Right Ovarian Cyst 2.1×1.6 cm + Fatty Liver
(Appendix - previously operated)
Diagnosis:
1. Simple Right Ovarian Cyst (functional) - causing RLQ pain
2. Non-Alcoholic Fatty Liver Disease (NAFLD) - incidental
Rx
──────────────────────────────────────────────────────────────
For Pain / Ovarian Cyst:
1. Tab. Mefenamic Acid 500 mg — 1 tab TDS after meals × 5 days
(Analgesic/anti-inflammatory; relieves ovarian cyst pain)
2. Tab. Drotaverine 40 mg — 1 tab TDS × 5 days
(Antispasmodic - smooth muscle relaxant for colic pain)
3. Tab. Pantoprazole 40 mg — 1 tab OD before breakfast × 7 days
(Gastric protection with NSAIDs)
For Fatty Liver:
4. Cap. Silymarin 140 mg — 1 cap BD after meals × 1 month
(Hepatoprotective - for NAFLD/fatty liver)
5. Tab. Vitamin E 400 IU — 1 tab OD after dinner × 1 month
(Antioxidant; evidence-based in NAFLD)
──────────────────────────────────────────────────────────────
Investigations Advised:
• CA-125 (tumour marker - to exclude ovarian malignancy,
especially given age 45)
• Repeat USG Pelvis after 6-8 weeks
(to confirm cyst resolution)
• LFT (Liver Function Tests) - for NAFLD baseline
• Fasting lipid profile, FBS (metabolic workup for fatty liver)
• Pelvic examination (bimanual)
──────────────────────────────────────────────────────────────
Advice:
• Avoid strenuous exercise/heavy lifting until cyst resolves
• If pain becomes SUDDEN & SEVERE → come to Emergency
immediately (rule out torsion/rupture)
• Low-fat, low-sugar diet for fatty liver
• 30 min walking daily
• Follow up after 6-8 weeks with repeat USG
Referral: Gynaecology OPD (for cyst follow-up and CA-125 review)
Dr. _______________
MBBS, MD
Reg. No: GUJ/XXXX
╚══════════════════════════════════════════════════════════════╝
Red Flag Signs - Tell Patient to Return IMMEDIATELY If:
| Red Flag | Concern |
|---|---|
| Sudden severe pelvic pain | Cyst rupture or ovarian torsion |
| Fever + pain | Tubo-ovarian abscess / PID |
| Vomiting + rigid abdomen | Torsion (surgical emergency) |
| Vaginal bleeding | Ruptured corpus luteum, ectopic |
Learning Points from This Case
- Always read the USG carefully - appendix was already operated, which completely changes the differential for RLQ pain
- Simple cysts <3 cm in premenopausal/perimenopausal women are almost always functional and resolve spontaneously in 4-8 weeks
- Conservative management (NSAIDs + repeat USG) is appropriate for a 2.1 cm simple cyst - Sabiston Surgery recommends "serial observation and management of symptoms" for functional ovarian cysts
- CA-125 is important at age 45 to exclude early ovarian malignancy even though USG features are benign
- Incidental findings matter - fatty liver found here; needs its own counseling and workup
- Retroverted uterus is a normal variant - not a pathological finding
"Conservative management with serial observation and management of symptoms of a patient with a functional ovarian cyst is advised. Surgical intervention, generally using a laparoscopic approach, is indicated for cysts that persist or enlarge." - Sabiston Textbook of Surgery, 21st Edition
B8BED116-0469-45D6-9481-A10203653F96.jpeg
45/F having RLQ pain since 1 week
This is the same case as the previous turn — I have already fully analyzed this USG report. Here is the complete summary for reference:
Case Recap: 45/F - RLQ Pain × 1 Week | Sumitraben Gohel
USG Findings (Dr. Naresh Hundiya Imaging Centre, Nadiad - 29 Mar 2025)
| Organ | Finding |
|---|---|
| Liver | Increased echogenicity = Fatty Liver |
| Gallbladder | Normal, no stones |
| Both Kidneys | Normal (10.5 cm bilateral) |
| Uterus | Normal, retroverted (normal variant) |
| Right Ovary | Simple cyst 2.1 × 1.6 cm - thin wall, no echoes, no septations |
| Left Ovary | Normal |
| Appendix | Already operated - rules out appendicitis |
| Peritoneum | No free fluid, no lymphadenopathy |
Impression: Simple Right Ovarian Cyst + Fatty Liver
Diagnosis & Differentials
| Priority | Diagnosis | Reason |
|---|---|---|
| ✅ Most likely | Simple Right Ovarian Cyst (functional) | USG confirmed, RLQ location |
| Consider | Corpus luteum cyst pain | Age 45, perimenopausal |
| Exclude | Ovarian torsion | Cyst small but possible - watch for red flags |
| Incidental | NAFLD (Fatty Liver) | Found on USG |
| Ruled out | Appendicitis | Appendix already removed |
Prescription
╔═══════════════════════════════════════════════════════════════╗
║ VED MULTISPECIALITY HOSPITAL, GUJARAT ║
║ GYNECOLOGY / PHYSICIAN OPD ║
╚═══════════════════════════════════════════════════════════════╝
Patient: Sumitraben Gohel Age: 45 yrs Sex: F
Date: 03/08/2026
Diagnosis:
1. Simple Right Ovarian Cyst (2.1×1.6 cm) - RLQ pain
2. NAFLD (Fatty Liver) - incidental finding
Rx
───────────────────────────────────────────────────────────────
FOR OVARIAN CYST / PAIN:
1. Tab. Mefenamic Acid 500 mg — 1 tab TDS after meals × 5 days
2. Tab. Drotaverine 40 mg — 1 tab TDS × 5 days
(Smooth muscle antispasmodic)
3. Tab. Pantoprazole 40 mg — 1 tab OD before breakfast × 7 days
(Gastric protection with NSAIDs)
FOR FATTY LIVER (NAFLD):
4. Cap. Silymarin 140 mg — 1 cap BD after meals × 1 month
5. Tab. Vitamin E 400 IU — 1 tab OD after dinner × 1 month
───────────────────────────────────────────────────────────────
Investigations:
• CA-125 (rule out ovarian malignancy - age 45)
• Repeat USG Pelvis after 6-8 weeks (confirm cyst resolution)
• LFT, Fasting lipid profile, FBS (NAFLD workup)
• Pelvic bimanual examination
Advice:
• Avoid heavy lifting and strenuous activity
• EMERGENCY if: sudden severe pain, vomiting, rigid abdomen
→ rule out cyst rupture / ovarian torsion
• Low-fat, low-sugar diet for fatty liver
• 30 min walking daily
Follow up: 6-8 weeks with repeat USG + CA-125 report
Dr. _______________
MBBS, MS (Gynaecology)
Reg. No: GUJ/XXXX
╚═══════════════════════════════════════════════════════════════╝
Key Teaching Points
- Appendix operated - always note surgical history; completely eliminates appendicitis from the differential
- Simple cysts <3 cm at reproductive/perimenopausal age are almost always functional - resolve in 4-8 weeks with expectant management
- CA-125 is mandatory at age 45 even for a "simple" cyst - age is a risk factor for ovarian malignancy
- Retroverted uterus - a normal anatomical variant, NOT a disease
- Two diagnoses in one USG - RLQ pain (cyst) + incidental fatty liver - both need addressing
- Red flag: if she comes back with sudden severe pain - think torsion or rupture - send to surgical/gynae emergency
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